Prognostic value of serum Mrp 8/14 in sepsis-induced acute respiratory distress syndrome patients: a retrospective cohort study

Abstract

Background: Mrp 8/14 is abundantly secreted by activated neutrophils during infection and inflammation. However, its prognostic value in acute respiratory distress dyndrome (ARDS) induced by sepsis is poorly understood. Our aim was to investigate the relationship between serum Mrp 8/14 and the prognosis in sepsis-induced ARDS patients admitted to the intensive care unit (ICU).

Methods: Serum Mrp 8/14 concentrations were analyzed in 118 ARDS patients induced by sepsis included in the analytical study. Patients were enrolled upon admission to the ICU of Nanjing Hospital affiliated to Nanjing Medical University. The baseline information and clinical outcomes were obtained. Patients were divided into survivor group and non-survivor group according to whether they died during ICU hospitalization.

Results: The serum Mrp 8/14 levels were significantly increased in the non-survivor group compared to the survivor group (P < 0.05). Logistic regression analysis showed that serum Mrp 8/14, albumin and APACHE II were the independent factors for predicting the prognosis of sepsis-induced ARDS during ICU hospitalization after adjustment. Additionally, the area under the receiver operating characteristic curve for Mrp 8/14 combined with albumin was associated with ICU mortality and was higher than that of Mrp 8/14, albumin, APACHE II and Mrp 8/14 combined with APACHE II (all P < 0.05). A nomogram was constructed to predict ICU mortality and the c-indexes of predictive accuracy was 0.830 in the cohort (P < 0.05).

Conclusions: The serum Mrp 8/14 upon ICU admission in septic patients may be useful for predicting mortality in sepsis-induced ARDS patients during ICU hospitalization.

Keywords: Acute respiratory distress dyndrome; Mortality; Mrp 8/14; Prognosis; Sepsis.

Figure 1. Flow chart of the study patients to illustrate study screening and ecruitment.

Abbreviations: COPD, chronic obstructive pulmonary disease; ARDS, Acute respiratory distress syndrome.

Figure 2. Forest plot of logistic regression analysis for ICU mortality.

The logistic regression analysis showed Mrp 8/14, LUS, Albumin and APACHE II were the independent fator for predicting the ICU mortality of ARDS induced by sepsis. Abbreviations: PCT, Procalcitonin; LUS, Lung ultrasound score; Bun, Blood urea nitrogen; ICU, Intensive care unit; Mrp 8/14, Myeloid-related proteins 8 and 14; ARDS, Acute respiratory distress syndrome; APACHE II score, Acute physiology and chronic health evaluation II score; SOFA score, Sequential Organ Failure Assessment score; CI, Confidence interval; OR, Odds ratio. P value below 0.05 indicate statistical significance.

Figure 3. Receiver operating characteristic (ROC) curve analysis of Mrp 8/14 for predicting the mortality of ARDS induced by sepsis during ICU hospitalization.

Abbreviations: ICU, Intensive care unit; Mrp 8/14, Myeloid-related proteins 8 and 14; ARDS, Acute respiratory distress syndrome; APACHE II score, Acute physiology and chronic health evaluation II score; AUC, Area under the curve. P value below 0.05 indicate statistical significance.

Figure 4. Nomogram of the study population to predict ICU mortality in ARDS induced by sepsis during ICU hospitalization.

The nomogram is used by summing the points assigned to the corresponding factors, which are presented at the top of the scale. The total is used to predict the ICU probability of mortality in the highest scale. The c-indexes values for the cohort (A) is 0.830. Calibration curve for ICU mortality, which is representative of predictive accuracy, for the cohort (B). The 45-degree reference line represents a perfect match between predicted and observed values. Abbreviations: ICU, Intensive care unit; Mrp 8/14, Myeloid-related proteins 8 and 14; ARDS, Acute respiratory distress syndrome; APACHE II score, Acute physiology and chronic health evaluation II score.